Cardiac Assessment Pa Exam 2

Front 1

what type of medication is coumadin and Plavix?

Back 1

anticoagulants

Front 2

HCTZ, furosemid/Lasix and spironolactone are examples of what type of medication?

Back 2

diuretics

Front 3

name three cholesterol lowering medications

Back 3

lipitor, zocor, crestor

Front 4

name three ACE inhibitors/Angiotensin converting enzyme inhibitors

Back 4

Zestril, Altace, Accupril

Front 5

Cozaar, Diovan and Avapro are what type of medications?

Back 5

ARB's/Angiotensin 2 receptor blockers

Front 6

what are two anti arrhythmic agents?

Back 6

digoxin and amiodarone

Front 7

what are nitrates and nitroglycerin?

Back 7

antianginals

Front 8

Norvasc, Cardezem and Adalat are what type of medications?

Back 8

calcium channel blockers

Front 9

what are inderal, corey, toprol, and tenormin?

Back 9

blockers

Front 10

what affect can Lasix have on your exam?

Back 10

diuretics may lower pressures

Front 11

what are the 7 symptoms of cardiac arrest?

Back 11

1.chest pain/pressure
2. shortness of breath
3. palpitations
4. syncope
5. sympathetic responses
6. atypical presentations
7. asymptomatic-left ventricular pulmonary disease

Front 12

where is the base of the heart located?

Back 12

usually to the right and left of the 2nd intercostal space (just below the S-M angle)

Front 13

where can you find the apex of the heart?

Back 13

normally found in the left 5th intercostal space at the mid clavicular line

Front 14

what part of the heart is used to gauge heart size and contractility?

Back 14

apex because it produces the apical impulse (PMI)

Front 15

where is the aortic arch located?

Back 15

at the S-M angle

Front 16

where is the right ventricle located?

Back 16

behind the sternum

Front 17

where is the right heart border?

Back 17

2-3cm right of midsternal line. right atrium makes up extreme right edge.

Front 18

patient presents with bulging veins in their neck and wheezing what should you be suspicious of?

Back 18

these are the jugular veins, can be affected by right sided heart failure

Front 19

when is Jugular Vein Distention abnormal?

Back 19

when it is >4cm above the sternal angle

Front 20

what are pulses?

Back 20

pressure wave in arteries

Front 21

what are impulses?

Back 21

tap of underlying ventricle swinging up and hitting the anterior chest wall

Front 22

what is a heave or lift?

Back 22

sustained lifting of the chest wall by underlying ventricular contraction

Front 23

what is a thrill?

Back 23

vibration cause by very turbulent blood flow through valve or vessels

Front 24

what do you suspect if the apical impulse is displayed laterally or not displaced at all?

Back 24

CHF

Front 25

What do you suspect if the apex of the heart is displaced down?

Back 25

COPD

Front 26

when is the size of the apex increased?

Back 26

LVH

Front 27

the duration of the impulse is delayed in?

Back 27

delayed ventricular emptying

Front 28

where do you feel for the apical impulse?

Back 28

between the 4th and 5th intercostal at the misclvicular line

Front 29

what are the four auscultatory areas?

Back 29

1. aortic-right sternal border 2nd intercostal space
2. pulmonic-left sternal border, 2nd intercostal space
3. tricuspid-left sternal border 5th intercostal space
4. mitral-medial to the midclavicular line, 5th intercostal space

Front 30

where is erg's point located?

Back 30

left sternal border 3rd intercostal space

Front 31

which heart sound is the closure of the mitral and tricuspid valve?

Back 31

S1

Front 32

what sounds is closure of the aortic and pulmonic vales?

Back 32

S2

Front 33

what is S3 and when is it heard?

Back 33

deceleration of blood against ventricular wall, will be heard just after S2

Front 34

what is S4 and when is it heard?

Back 34

Atrial contraction against higher ventricular pressures. will hear just before S1

Front 35

when reading an electrocardiogram which heart sound corresponds with QRS?

Back 35

S1

Front 36

what does a S3 gallop represent?

Back 36

failure of volume overloaded ventricle
"Kentucky"

Front 37

what does a S4 gallop represent?

Back 37

stiff, thickened LV wall with HTN, AS, post MI "Tennessee"

Front 38

Cardiac Anatomy: what is the base of the heart and where is it found?

Back 38

Portion of the heart where all the great vessels attach. Usually refers to the right and left 2nd intercostal space; just below the S-m angle

Front 39

Where is the apex of the heart located on the front of the chest?

Back 39

in the left 5th intercostal space at the mid clavicular line

Front 40

What is used to gauge heart size and contractility?

Back 40

PMI/point of maximal impulse; produced by the apical impulse

Front 41

where is the right heart border?

Back 41

2-3cm right of the midsternal line

Front 42

what might you notice on a patient with right sided heart failure?

Back 42

Extended jugular veins

Front 43

what is an abnormal JVD presentation? what are you worried about?

Back 43

JVD >4cm above the sternal angle is abnormal. you worry that they have alot of fluid on their heart-possible or possible COPD. test performed with pt. supine.

Front 44

with palpation what are pulses?

Back 44

pressure wave in arteries

Front 45

what are impulses?

Back 45

tap of underlying ventricle swinging up and hitting the anterior chest wall

Front 46

what is a heave or lift?

Back 46

sustained lifting of the chest wall by underlying ventricular contraction

Front 47

what is a thrill?

Back 47

vibration cause by very turbulent blood flow through valve or vessel

Front 48

name 6 causes of hyper dynamic intensity of PMI

Back 48

1. anemia
2. hyperthyroid
3. HTN
4. AS
5. Volume overload
6. MR

Front 49

what are the auscultatory areas?

Back 49

1. aortic-right sternal border, 2nd intercostal space
2. tricuspid-left sternal border 5th intercostal space
3. pulmonic-left sternal border 2nd intercostal space
4. mitral-medial to midclavicular line, 5th intercostal space

Front 50

what can lead to pathologic splitting of S1

Back 50

split heard outside pulmonic area; with increased right ventricular pressure (valvular dz) or delayed RV contraction

Front 51

what can cause a pathologic S2 split?

Back 51

delayed LV contraction

Front 52

what is a murmur? when is called a bruit?

Back 52

turbulent blood flow through valves. called a bruit if heard over vessels.

Front 53

what can cause abnormal systolic murmurs between S1 and S2?

Back 53

aortic stenosis and mitral regurgitation

Front 54

what can cause abnormal diastolic murmurs?

Back 54

aortic insufficiency and mitral stenosis

Front 55

when would you hear a rub?

Back 55

pericarditis or pericardial effusion

Front 56

what are 7 risk factors for coronary artery disease?

Back 56

1. HTN
2. DM
3. Hyperlipidemia
4. Smoking
5. Family Hx
6. Age
7. Obesity

Front 57

what is a sign you can see with your patient that may indicate a possible MI? what might this patient complain of?

Back 57

1. sweating-diaphoresis
2. will also have tachycardia
3. may complain and nausea and substernal chest pain (indigestion)

Front 58

patient complain of jaw pain, happens when they go out into the cold, but doesn't last longer than than 20 minutes. what do you suspect?

Back 58

Angina Pectoris-dull pressing pain that radiate to jaw/L arm. lasting for a short duration. can be precipitated by stress, cold and exertion

Front 59

patient complain of a dull pressing pain in their jaw. the pain lasts only a couple minutes but seems to be related to stress. wha two you expect?

Back 59

unstable angina. 15% progress to MI

Front 60

name 3 cardiac biomarkers

Back 60

1. creatine kinase
2. lactate dehydrogenase
3. myoglobin
4. tropnin I and T

Front 61

what is the best test for a rapid diagnosis of MI? which test will not longer appear elevated after 3 days? which markers are still present one week after the MI?

Back 61

1. Troponin I levels
2. Creatine Phosphokinase-last up to 72hrs., myoglobin last only 24 hrs.,
3. Troponin I can still be affected for 14 days; lactate dehydrogenase can last up to 8 days
3.

Front 62

what should you do if you suspect your patient is having an MI?

Back 62

1. give aspirin
2. call 911
3. have AED available
4. give supplemental O2 if available

Front 63

patient complains that they sometimes experience a gray out of their vision and feel exhausted often. what do you suspect?

Back 63

heart block

Front 64

young patient with HR of 200/min without disruption. what do you suspect?

Back 64

paroxysmal atrial tachycardia

Front 65

patient has a rapid and weakened heart rhythm of 300/min. QRS is absent form EKG. dx?

Back 65

ventricular fibrillation-grave prognostic sign of sudden death. tx. AED